GI neoplasms part 2: esophageal, gastric and biliary-mcgowan Flashcards

1
Q

who is more likely to get esophageal cancer

A

Men>Women (4:1) - new cases and deaths

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2
Q

what is included in esophageal cancer

A

gastroesophageal junction (GEJ) and 5cm into the stomach

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3
Q

what is the most common esophageal cancer

A

adenocarcinoma = most secondary to Barretts

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4
Q

where in the world in SCC the more prevalent esophageal cancer

A

asia and sub-saharan africa

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5
Q

what is the later findings of esophageal cancers (presentation)

A

dysphagia (progressive over weeks to months)
weight loss
+/- odynophagia, heart burn, dyspepsia, bleeding, coughing, pneumonia, chest/mediastinal/back pain, hoarseness, lymphadenopathy

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6
Q

what is the test of choice for esophageal cancer

A

EDG with biopsy - establishes diagnosis

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7
Q

what tests are completed after diagnosis of esophageal cancer is confirmed

A

CBC to check for anemia
LFTs to check AST, ALT and alk phos
CT of check, abdomen, pelvis - look for regional spread
PET CT for distal spread
Endoscopic US - assess depth of tumor and nodes
+/- FNA of any possibly involved nodes

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8
Q

what is the treatment for localized esophageal cancer

A

endoscopic resection or esophagectomy

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9
Q

what is the treatment of localized esophageal cancer with lymph nodes involved

A

chemo and/or radiation, then esophagectomy + lymphnodeectomy

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10
Q

what is the treatment for distant spread esophageal cancer

A

palliative tx with chemo and or radiation
esophageal stending
local brachytherapy
jujunostomy or gastrostomy tube for nutrition

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11
Q

what are the prevention methods for esophageal ccancer

A

no routine screening
monitor/follow up for Barretts esophagus
encourage lifestyle modifications
NSAIDs may be protective
Anti-acid medications may be protective

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12
Q

what are risk factors for gastric cancer

A

H/pylori infection/gastritis strongest overall risk factor
pernicious anemia, hx partial gastric resection, smoking, high nitrate/salt diets, low vitamin C diet, hereditary tumor syndromes

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13
Q

what is the most common type of gastric cancer

A

adenocarcinoma
proximal - secondary to metaplasia
distal - secondary to H. pylori infection

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14
Q

what is intestival gastric cancer

A

more common
metaplasia of glandular structures
H. pyloria - atrophic gastritis - metaplasia - dysplasia - CA

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15
Q

what is diffuse gastric cancer

A

poorly differentiated, less glandular
less related to h.pylori, mor ehereditary

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16
Q

what are the different morphologies of gastric cancer

A

fungating
poylpoid
ulcerating
diffusely spreading
superficial spreading

17
Q

what is the later symptoms of gastric CA

A

dyspepsia
early satiety
epigastric pain
anorexia
weight loss
+/- signs of UGI bleeding, post prandial vomiting, dysphagia

18
Q

what is virchow node

A

palpable left supraclavicular lymph node

19
Q

what is sister mary joseph nodule

A

umbilical nodule

20
Q

what is the test of choice for gastric cancer

A

EGD with biopsy
-age 55+ with new epigastric symptoms, persistent dyspepsia, often with barium swallow

21
Q

what further tests are completed once gastric cancer is confirmed

A

EUS for depth and spread, CT C/A/P, PET for distal mets

22
Q

what is the treatment of localized gastric CA

A

laparoscopic or open gastrectomy (either total or subtotal) + lymphadenectomy
need vit B12 supplemental after gastrectomy
preop chemo and/or radiation improves survival

23
Q

what is the treatment of advanced (non-locally resectable) gastric cancer disease

A

palliative treatment

24
Q

what is cholangiocarcinoma

A

carcinoma of the gallbladder itself or the bile duct

25
Q

what are risk factors for GB cancer

A

cholelithiasis
salmonella typhii infection
gallbladder polyps
calcification of the gallbladder (porcelain gallbladder)
genetics (K-ras and P52 mutations)

26
Q

what are risk factors for cholangiocarcinoma

A

bile duct adenomas
ulcerativ colitis
primary sclerosing cholangitis
biliary cirrhosis
DM
hyperthyroidism
chronic pancreatitis
ETOH - heavy consumption
smoking
HIV/HCV
NAFLD/cirrhosis
obesity
helmith infection of bile ducts (SE Asia)

27
Q

what can reduce the risk of all types of bile duct cancer

A

ASA and statin

28
Q

what can reduce the risk of intra-hepatic cholangiocarcinoma

A

metformin

29
Q

what is the presentation of biliary A

A

progressive jaundice signaling obstruction
RUQ abdominal pain
anorexia and weight loss
+/- fever and chills, hematemesis or melena, pruritis and skin excoriations

30
Q

what is seen on PE with biliary CA

A

jaundice (in severe dz)
palpable gallbladder
Hepatomegaly (tender)
+/- ascites

31
Q

what is the Courvoisier sign

A

palpable nontender GB + obstructive jaundice
*suggests malignancy

32
Q

what is the laboratory workup of biliary CA

A

elevated conjugated (indirect) bilirubin
+/- elevated alk phos and cholesterol
AST normal to mildly elevated
Elevated CA19-9 (tumor marker)

33
Q

what is the test of choice for biliary CA

A

MRI with magnetic resonance cholangiopancreatography (MRCP)

34
Q

what is the benefit of MRCP

A

visualization of entire biliary tree
defines extent of involvement
elucidates any vascular involvement

35
Q

what is the treatment of biliary CA

A

mainstay = surgery
-young and fit: cholecystectomy

if sx not an option - palliative tx